Form ENT-XIV See rule 28(1) Certificate of Recovery under Section 7 of Goa Entertainment Tax Act 1964 WARD NAME REGN . CERTIFICATE NO. 1. Name & Style of activity of defaulter 2. Address of the Place of entertainment Main Office Additional place 1 Additional place 2 Additional place 3 3. Constitution of the defaulter entity Nature Names & Address of Partners/ Proprietors/ Managing Director/ Office bearers/ Key persons 1. 2. 3. 4. 5. 4A. Amount to be recovered 4B. Period to which dues pertain 5, Details of Assets of defaulter 6. Head of account to which the amount is to be credited Date of Issue of RC Signature of AA Seal
